Plasmakonzentrationen von Bupivacain bei kontinuierlicher Periduralanästhesie im Kindesalter

Zur postoperativen Schmerztherapie bei Kindern mit Operationen an der unteren Korperhalfte bietet sich eine Periduralanasthesie an. Bisher wurde die initiale Pharmakokinetik bei Kindern untersucht, nicht hingegen der langfristige Verlauf. Ziel dieser Untersuchung war die Erhebung von Daten zum zeitlichen Verlauf des Plasma-Bupivacainspiegels, der sauren α1-Glycoprotein- und Albuminkonzentrationen bei Kindern mit kontinuierlicher Periduralanasthesie in der postoperativen Phase. Methodik:Uber eine 19G Tuohy-Kanule legten wir einen Katheter mit 0,63 mm Ausendurchmesser in den Periduralraum ein. Wahrend der kontinuierlichen periduralen Bupivacaininfusion durfte eine Dosis von 0,4 mg/kgKG/h Bupi…

Intubationsbedingungen nach Rocuronium und Succinylcholin

OBJECTIVE Rocuronium is a new non-depolarising steroidal muscle relaxant with a short onset time. The present study was undertaken to compare intubating conditions as well as onset and clinical duration of a single dose of 0.6 mg/kg (2 x ED95) with a single dose of 1 mg/kg suxamethonium (3 x ED95). METHODS After obtaining informed consent and approval of the Ethics Committee, 40 adult patients (ASA I-III) participated in this study. After premedication with oxazepam, anaesthesia was induced with fentanyl and propofol and maintained with propofol, N2O and supplements of fentanyl as needed. Muscular relaxation was assessed by EMG recording of adductor pollicis muscle after supramaximal single…

Die schwierige Intubation

Fur die Definition der schwierigen Intubation ist es sinnvoll, drei Teilvorgange der Intubation zu unterscheiden.

Beeinflussung der Pharmakodynamik von Rocuronium durch Cimetidin

Nach Gabe von Cimetidin kann die Wirkungszeit nichtdepolarisierender Muskelrelaxanzien verlangert sein. Wir untersuchten diesen Zusammenhang fur Rocuronium nach einer Einzeldosis von 400 mg Cimetidin intravenos im Vergleich mit einer Kontrollgruppe. Die Antwort des M. adductor pollicis nach Stimulation des N. ulnaris wurde elektromyographisch registriert. Die Anschlags- und Erholungszeiten sind in beiden Gruppen vergleichbar. Der fehlende Einflus von Cimetidin auf die neuromuskulare Blockade von Rocuronium konnte darauf hindeuten, das die Elimination von Rocuronium nicht nur in der Leber stattfindet. Eine mogliche direkte Beeinflussung der neuromuskularen Endplatte durch Cimetidin, wie sie …

Prolonged anaesthesia with isoflurane and halothane. Effects on hepatic function.

Hepatic function was assessed pre-operatively and on the first and sixth postoperative days in 40 healthy patients who underwent prolonged maxillofacial surgery with isoflurane or halothane anaesthesia. No major changes were observed in hepatic enzymes or bilirubin. One-stage prothrombin time and Factor VII concentrations decreased on the first postoperative day and this change was more pronounced in the halothane group. The results support the use of isoflurane rather than halothane for prolonged anaesthesia in respect of the synthesising function of the liver.

Effects of normobaric oxygen on ciliary beat frequency of human respiratory epithelium

Respiratory infection is a major cause of morbidity after general anaesthesia. Impairment of respiratory ciliary beat frequency (CBF) by different stress factors causes a decrease in mucus transport rate (MTR). We have tested the effect of different concentrations of oxygen on CBF of human respiratory epithelium in a prospective, randomized, in vitro study. Samples of superficial mucosa of the inferior nasal turbinates of 20 non-smoking healthy volunteers were harvested and exposed to three different oxygen environments (group I = 21% oxygen, group II = 60% oxygen and group III = 95% oxygen) for 2 h. In 50% of the samples, exposure time was prolonged. At 30, 60, 90, 120 and 240 min, light m…

Die schwierige Intubation

'Anestheticography': on-line monitoring and documentation of inhalational anesthesia.

The safe practice of inhalational anesthesia requires control over the amount of volatile anesthetic delivered to the patient. With minimal fresh gas flow this is facilitated by continuous monitoring and recording of the agent's concentration ('Anestheticography'). Alterations brought about by routine clinical maneuvers become visible. We recorded the course of the inspiratory and expiratory concentration of volatile anesthetic (Isoflurane) by infrared absorption and a trend recorder. Changing the carrier gas composition during high flow from 75% to 25% nitrous oxide in oxygen resulted in a 10% increase of the inspiratory isoflurane concentration. Activating the oxygen bypass or exchanging …